Weakened by nine days without food, 12 boys and their football coach trapped in a Thai cave are fighting threats to their health ranging from muscle degeneration and malnutrition to possible infection, experts said Tuesday.

But the group's survival may ultimately hinge on mental rather than physical toughness -- not losing hope while rescuers figure out how to free them from the dark, wet cavern, a process that could take weeks or even months.

"The mental side of this has to be one of the top considerations," said Andrew Watson, an experienced rescuer of mineworkers trapped by floods or fire.

On Monday, rescue divers finally reached the cave holding the players, aged 11-16, and their coach -- all 13 hungry and bedraggled but amazingly alive.

After initial euphoria, however, the children and their guardian learnt they will have to stay longer while rescuers consider various options.

The safest is to wait for the floodwaters trapping the group to subside.

Another is to teach the kids to undertake the perilous dive themselves -- it took trained rescue divers six hours to navigate the treacherous, muddy waterway into the cave.

"The uncertainty of when and how they might be rescued will be beginning to set in," Neil Greenberg, an expert in post-traumatic stress disorder at King's College London told AFP.

"When the divers got through, the kids, the thought process (would have been): 'They get in, why can't I get out?'" added Watson, commercial director at the Mines Rescue Service UK.

"It depends now how they're communicating the circumstances to the children... You have to tell them just exactly what the circumstances are because... they need to understand that this is a difficult process that will require patience. Possibly a lot of patience."

- Space, sanitation -

Physically, the priority is to nourish and rehydrate the group and rebuild lost strength.

For Mike Tipton of the University of Portsmouth the fact that the footballers endured in the cave for nine days implied that three key ingredients for survival were in place: oxygen, a tolerable temperature, drinkable water.

Next to consider: "Things like what's the sanitation like? Are they disciplined in order that they don't get outbreaks of disease? That could be the next... threat," said Tipton, an expert in the effects of extreme environments on the human body.

Once the group starts eating again, they will need safe sanitation to ensure waste is washed away and doesn't pollute their drinking water.

The floodwater itself may also be contaminated with sewage or dead animals, Tipton pointed out.

A further concern: "How much space do they have?"

Being confined and sedentary for an extended period can result in muscle atrophy, or wastage, which can cause temporary muscular and skeletal problems.

The weaker the children are, the more difficult they will find a dive to freedom, said the experts.

"It is going to be a very, very major decision," according to Watson, who judges it "far safer" to wait for the water to clear, if at all possible.

- Stay or swim? -

"We have to bear in mind these are children," he stressed. "You are talking about water: it's going to be moving, there's going to be pressure, there's going to be resistance, it's not going to be clear, and they've no experience of the breathing apparatus."

Just one individual panicking in the water could have a disastrous ripple effect.

If conditions allow the group to stay in the cave, it will be important for them to keep busy, focused and positive, said Tipton.

A good leader can turn the experience into "an adventure as opposed to a challenge".

Once communications are established, the children's parents must keep their cool, added the experts.

"Anxiety expressed by their families could easily erode a child's resilience," warned Greenberg.

"A positive 'it'll be just fine' approach may be an effective way of allaying their fears."

Jean-Noel Dubois, a French spelunking rescuer and medic, said group cohesion has been shown to help pull people through situations like these.

"They are together," he said of the stranded footballers. "What people tell us after an underground rescue is that it is easier to persevere if one is part of a group and one has hope."

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